2016/17 Activity Report April August/September 2016

Transcription

1 Due to a change in national hospital data flows (SUS) and also a delay in processing September 2016 Practice-level finance data, the latest information on hospital activity and spend is still up to August /17 Activity Report April August/September 2016 Section Page Key Points 2 4 CCG Demographics 5 e-referrals to Outpatient Clinics 6 Outpatient First Attendances (GP Referrals) 7 Outpatient First Attendances (All referral sources) 8 Outpatient Follow-up Attendances 9 Day Case Admissions 10 Elective Inpatient Admissions (overnight stay) 11 Emergency Admissions A&E Attendances NHS 111 Calls 17 NUH & Circle Fast Track Reports GP Practices Financial Performance against Commissioning Budget GP Prescribing 22

2 Key Points: Elective Activity This report focuses on hospital activity trends and rates. It is largely based on SUS data up to August 2016 (Year to Month 5) and includes both specialised and non-specialised activity. Warning: Following the closure of the Surgery in June 2016, figures for the have been removed from tables and charts in this report for statistical reasons. Outpatient Attendances Outpatient first appointments (seen) from GP Referral this year to August are 8% higher than in the same period last year (SUS). ereferrals data (formerly Choose & Book) up to September shows a 14% increase in GP referrals from last year. There has been an increase in GP Referrals to OP in the following specialties: T&O; Ophthalmology; Urology; Dermatology; Pain Management; ENT; Paediatrics; Breast Surgery; Outpatient first attendances from all referral sources are up by 6% from last year. NNE QIPP Target for 2016/17 is -6.5% Outpatient Follow-up attendances (all providers) are 4% higher than last year. Latest 2016/17 Fast Track data from NUH and Circle (up to 30 October 2016) shows a 3.5% increase in All OP 1st activity compared with the same period last year (6.5% increase for OP 1 st from GP referral). Day Case & Elective Admissions Day Case (DC) admissions have increased by 9% compared with last year (all providers). The increase is seen mainly at NUH and Circle. DC activity has increased in the following specialties: Gastroenterology; Pain Management; Clinical Oncology; Ophthalmology, Colorectal Surgery; Dermatology QIPP Target for 2016/17 is -4.6% Year-on-year Ordinary Elective admissions with overnight stay (EL) have increased by 2% (all providers). Latest 2016/17 Fast Track data from NUH and Circle shows: 10% increase in Day Case activity compared with last year 0.3% decrease in Elective Spells compared with last year. 2

3 Key Points: Emergency Activity A&E The total number of ED attendances at Type 1 (24/7 consultant led Major ED), Type 2 (Mono-specialty consultant led ED, e.g. Eye Casualty) and Type 3 (Minor Injury) Departments is 5.4% higher than last year. Attendances at Type 1 only Departments (Major 24/7 ED) have increased by 4.3%. The largest increase has occurred in the (+14%) and 85+ age group (+17%). Latest 2016/17 Fast Track data from NUH shows that ED attendances at the QMC Type 1 A&E are 4.8% higher than last year. The number of calls to NHS 111 Telephone Line this year (up to October 2016) is slightly higher than last year (+0.2%). Emergency Admissions This year to date Emergency hospital admissions (all providers) are slightly higher than last year (+0.6%; n=37). The largest increase has occurred in: Urinary Tract Infections; Respiratory Infections (e.g. Pneumonia); Viral Infections and Sepsis Emergency admissions from GP are lower than last year (-4.2%) QIPP Target for Emergency Admissions in 2016/17 is -6.9% 28-day emergency re-admissions this year are slightly up from last year (+0.4%). Latest 2016/17 Fast Track data from NUH shows that the number of emergency admissions this year to date is 3% higher than last year. 3

4 Key Points: Financial Position at the 3 Main Providers University Hospitals NHS Trust (NUH) In Month 6 (April to September), NNE has over-spent at NUH Main areas of YTD over-spend are: Day Case (DC): 11% ( 347,613): Ophthalmology, Clinical Oncology, Plastic Surgery, Breast Surgery, Hepatology Emergency Admissions (NEL): 4% ( 372,009) Mostly QIPP non-delivery; Septicaemia; Heart Failure; Multiple Trauma Outpatient First (OPFA): 8% ( 131,147) Across several specialties, including: Gastroenterology, Urology, General Surgery, Paediatrics, ENT; T&O; Gynaecology Outpatient Procedures (OPPROC): 16% ( 210,526): Fracture Clinic ( 123k); Ophthalmology; Gynaecology; ENT Accident & Emergency (A&E): 15% ( 238,897) Circle Ltd Treatment Centre In Month 6 (April to September), NNE has over-spent at Circle Main areas of YTD over-spend are: QIPP (non-delivery): 270,410 Outpatients (First, Follow-ups, OP Procedures): 248,338 Pain Management; Dermatology; T&O; Rheumatology High Cost Drugs: 83,228 mainly Cytokine inhibitors (Rheumatology and Gastroenterology) Elective (overnight stay): 82,228 mainly T&O Sherwood Forest Hospitals NHS Foundation Trust (SFH) In Month 6 (April to September), NNE has under-spent at SFH (-1%, - 41,022) Main areas of over-spend are: Emergency Admissions; Critical Care and High Cost Drugs 4

5 % Patients Aged 75+ Deprivation Score CCG Demographics 18% Patients aged 75+ as % of Total Practice Population NNE West Rushcliffe 30 Deprivation score (IMD 2015) NNE West Rushcliffe 16% 14% 25 12% 20 10% 8% 15 6% 10 4% 2% 5 0% 0 5

6 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Number of Referrals 2,200 2,000 1,800 1,600 1,400 1,200 1, GP e-referrals to Outpatient Clinics (ereferrals Service) North & East - ereferrals to Outpatient Clinics (All Specialties) 2014/ / /17 Data Mean Value LCL LAL UAL UCL e-referrals: Advice & Guidance Requests Oct-15 to Sep-16 Highest South Notts CCG Rate 2014/ / /2017 YTD YTD YTD from last Year ereferrals Specialty (Top 20 only) % 2WW 2,212 2,067 2, % Ophthalmology 1,222 1,139 1, % Podiatry 1, % GI and Liver (Medicine and Surgery) , % Orthopaedics , % Children's & Adolescent Services % Gynaecology % Ear, Nose & Throat % Cardiology % Urology % Neurology % Surgery - Not Otherwise Specified % Dermatology % Rheumatology % Pain Management % Respiratory Medicine % Surgery - Vascular % Endocrinology and Metabolic Medicine % Surgery - Breast % Sleep Medicine % 11,962 10,731 12,030 1,299 12% 6

7 Number of Attendances GP Referrals to Outpatient First Attendances (SUS Data) Outpatient First Attendances from GP Referral - April 16 to August West Rushcliffe Mansfield & North & East Ashfield City City & County CCGs Rate Newark & Sherwood Outpatient First Attendances from GP Referral - NNE CCG Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Outpatient First Attendances from GP Referral - April 16 to August 16 Lowest South Notts CCG Rate Practice 2014/ / /2017 from Last 2 Years Average % % % , % % 1,237 1,001 1, % % % % % % % % % 968 1, % 1,324 1,225 1, % % % % % % % Grand Total 13,097 12,214 13, % 7

8 Number of Attendances Outpatient First Attendances from all Referral Sources 190 Outpatient First Attendances from All Referral Sources - April 16 to August All Outpatient First Attendances - NNE CCG Rushcliffe West North & East City City & County CCGs Rate Mansfield & Ashfield Newark & Sherwood Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Outpatient First Attendances from All Referral Sources - April 16 to August Lowest South Notts CCG Rate Practice 2014/ / /2017 from Last 2 Years Average % % 1,298 1,128 1, % 1,476 1,366 1, % % 1,892 1,690 1, % % % % , % % 1,097 1,110 1, % % % 1,580 1,573 1, % 2,136 2,039 2, % 1,531 1,439 1, % % % 1,017 1, % 1,508 1,335 1, % % Grand Total 20,848 19,941 21, % 8

9 Number of Attendances Outpatient Follow-up Attendances Outpatient Follow-up Attendances - April 16 to August 16 Outpatient Follow-up Attendances - NNE CCG Rushcliffe West City North & East City & County CCGs Rate Newark & Sherwood Mansfield & Ashfield Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Outpatient Follow-up Attendances - April 16 to August 16 Lowest South Notts CCG Rate Practice 2014/ / /2017 from Last 2 Years Average % 1,251 1,377 1, % 2,949 3,263 3, % 3,275 3,160 3, % 1,497 1,384 1, % 4,061 4,225 4, % 1,305 1,376 1, % % 1,975 2,313 2, % 2,209 2,309 2, % % 2,362 2,460 2, % 1,478 1,662 1, % 1,801 2,048 2, % 3,844 3,938 4, % 4,678 4,781 4, % 3,445 3,455 3, % 1,279 1,238 1, % 1,576 1,602 1, % 2,633 2,523 2, % 3,832 3,677 3, % 1,240 1, % Grand Total 48,190 49,294 51,047 2,305 5% 9

10 Number of Admissions Day Case Hospital Admissions Day Case Hospital Spells - April 16 to August 16 Day Case Admissions - NNE CCG Rushcliffe Mansfield & North & East West City Ashfield City & County CCGs Rate Newark & Sherwood Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Day Case Hospital Spells - April 16 to August 16 Lowest South Notts CCG Rate Practice 2014/ / /2017 from Last 2 Years Average % % % % % % % % % % % % % % % % % % % % % % Grand Total % 10

11 Number of Admissions Ordinary Elective Hospital Admissions (Overnight Stay) 12.0 Elective (Overnight Stay) Hospital Spells - April 16 to August Elective Overnight Stay Admissions - NNE CCG West Rushcliffe North & East City City & County CCGs Rate Mansfield & Ashfield Newark & Sherwood Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Elective (Overnight Stay) Hospital Spells - April 16 to August 16 Lowest South Notts CCG Rate Practice 2014/ / /2017 from Last 2 Years Average % % % % % % % % % % % % % % % % % % % % % % Grand Total % 11

12 Number of Admissions Emergency Hospital Admissions (All) All Emergency Hospital Spells - April 16 to August 16 All Emergency Admissions - NNE CCG Rushcliffe West North & East Newark & Sherwood City & County CCGs Rate City Mansfield & Ashfield Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar All Emergency Hospital Spells - April 16 to August 16 Lowest South Notts CCG Rate Practice 2014/ / /2017 from Last 2 Years Average % % % % % % % % % % % % % % % % % % % % % % Grand Total % 12

13 Number of Admissions Emergency Hospital Admissions (from GP) GP Emergency Hospital Spells - April 16 to August 16 Emergency Admissions from GP - NNE CCG Newark & Sherwood Rushcliffe Mansfield & Ashfield City & County CCGs Rate North & East West City Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar GP Emergency Hospital Spells - April 16 to August 16 Lowest South Notts CCG Rate Practice 2014/ / /2017 from Last 2 Years Average % % % % % % % % % % % % % % % % % % % % % % Grand Total % 13

14 Number of Attendances Emergency Hospital Re-Admissions within 28 Days (All Providers) Emergency Readmissions within 28 Days from Discharge - April 16 to August Emergency Readmissions within 28 days from Discharge - NNE CCG Rushcliffe West North & East Newark & Sherwood City & County CCGs Rate City Mansfield & Ashfield Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Emergency Readmissions within 28 Days from Discharge - April 16 to August 16 Lowest South Notts CCG Rate Practice 2014/ / /2017 from Last 2 Years Average % % % % % % % % % % % % % % % % % % % % % % Grand Total 1,209 1,124 1, % 14

15 Number of Attendances A&E Attendances at Type 1 and 2 Emergency Departments Type 1 and Type 2 Emergency Departments A&E Attendances - April 16 to August A&E Attendances (Type 1 & 2 Only) Rushcliffe West North & East City City & County CCGs Rate Mansfield & Ashfield Newark & Sherwood Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Type 1 and Type 2 Emergency Departments A&E Attendances - April 16 to August 16 Lowest South Notts CCG Rate Practice 2014/ / /2017 from Last 2 Years Average % % % % % % % % % % % % % % % % % % % % % % Grand Total % 15

16 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Number of Attendances Attendances at Minor Injury Units and NHS Urgent Care Centres Minor Injury Units and Urgent Care Centres Attendances - April 16 to August Mansfield & Ashfield Newark & Sherwood Rushcliffe West North & East City Minor Injury Units and Urgent Care Centres City & County CCGs Rate Minor Injury Units and Urgent Care Centres Attendances - April 16 to August 16 Lowest South Notts CCG Rate Practice 2014/ / /2017 from Last Year % % % % % % % % % % % % % % % % % % % % % % Grand Total % 16

17 Number of Calls NHS 111 Calls (Derbyshire Health United) 140 NHS 111 Calls - April 16 to October 16 3,500 NNE CCG - Number of NHS 111 Calls (Source: DHU) , Rushcliffe West North & East Newark & Sherwood City Mansfield & Ashfield 2,500 2,000 1,500 1, / / /17 City & County CCGs Rate NHS 111 Calls - April 16 to October 16 Lowest South Notts CCG Rate NNE CCG Disposition Category /17 YTD % Contact Primary Care Service 35% Emergency Ambulance 14% Speak to Primary Care service 11% Attend A&E 10% Non Clinical Enquiry 10% Contact a Dental Practitioner or Pharmacist 8% Recommended Home Care 5% Attend another service 4% Health Information 2% Not Known 1% Total 100% 17

18 Locality 3 Locality 2 Locality 1 NUH & Circle Weekly Fast Track Data for 2016/17 - from Last Year 4 April 2016 to 30 October 2016 compared to same period in 2015/16 Outpatient First ALL Referrals Outpatient First GP Referrals Outpatient Followup (including OP Procedures) Day Case Code Practice % % % % % % % % % Elective A&E (QMC Major ED) Emergency All Emergency GP Population Change Sep 15 - Sep 16 C84053 Torkard % % % % % % % % % C % % % % 9 9.7% % % 2 3.6% % C % % % % % % % % % C % % % % % % % 6 8.6% % C % % % % % % % 1 3.3% % Y00026 Om 6 2.1% 7 4.5% % % % % % % % Total for locality % % % % % % % % % C % % % % % 4 0.3% % % % C % % % % % % % % % C % % % % 6 3.3% % % % % C % % % % % % % % % C % % 3 0.2% % % % 4 2.5% % % C % % % % % % % % % C % % % % % 5 1.7% % % % Total for locality % % % % % % 9 0.3% 0 % % C % % % % % % % % % C84033 Lane % % % % % % % % % C % % % % % % % % % C % % % % % % % 5 8.9% % C % % % % 4 8.2% % % % % C % % % % % % % % -2, % C % % % % % % % % % C % 4 0.4% % % % % % 5 8.8% 1, % Total for locality % % 1, % % % % % % % Grand Total NNE % 1, % 3, % % % % % % 1, % Colour Source: NUH & Circle Fast Track Datasets (data includes both specialised and non-specialised activity) Legend Actvity % Population Increase <= -20 <= -5% > = 2% <= -10 <= -1% <= -2% >= 10 >= 1% >= 20 >= 5% POD OP 1st Daycase QIPP Target (%) -6.5% -4.6% Elective % A&E -14.9% Emergency -6.9% Actual % Change 3.5% 10.4% -0.3% 4.8% 2.9% 18

19 31/03/14 14/04/14 28/04/14 12/05/14 26/05/14 09/06/14 23/06/14 07/07/14 21/07/14 04/08/14 18/08/14 01/09/14 15/09/14 29/09/14 13/10/14 27/10/14 10/11/14 24/11/14 08/12/14 22/12/14 05/01/15 19/01/15 02/02/15 16/02/15 02/03/15 16/03/15 30/03/15 13/04/15 27/04/15 11/05/15 25/05/15 08/06/15 22/06/15 06/07/15 20/07/15 03/08/15 17/08/15 31/08/15 14/09/15 28/09/15 12/10/15 26/10/15 09/11/15 23/11/15 07/12/15 21/12/15 04/01/16 18/01/16 01/02/16 15/02/16 29/02/16 14/03/16 28/03/16 11/04/16 25/04/16 09/05/16 23/05/16 06/06/16 20/06/16 04/07/16 18/07/16 01/08/16 15/08/16 29/08/16 12/09/16 26/09/16 10/10/16 24/10/16 31/03/14 14/04/14 28/04/14 12/05/14 26/05/14 09/06/14 23/06/14 07/07/14 21/07/14 04/08/14 18/08/14 01/09/14 15/09/14 29/09/14 13/10/14 27/10/14 10/11/14 24/11/14 08/12/14 22/12/14 12/01/15 26/01/15 09/02/15 23/02/15 09/03/15 23/03/15 06/04/15 20/04/15 04/05/15 18/05/15 01/06/15 15/06/15 29/06/15 13/07/15 27/07/15 10/08/15 24/08/15 07/09/15 21/09/15 05/10/15 19/10/15 02/11/15 16/11/15 30/11/15 14/12/15 28/12/15 18/01/16 01/02/16 15/02/16 29/02/16 14/03/16 28/03/16 11/04/16 25/04/16 09/05/16 23/05/16 06/06/16 20/06/16 04/07/16 18/07/16 01/08/16 15/08/16 29/08/16 12/09/16 26/09/16 10/10/16 24/10/16 Number of A&E Attendances Number of Admissions 31/03/14 14/04/14 28/04/14 12/05/14 26/05/14 09/06/14 23/06/14 07/07/14 21/07/14 04/08/14 18/08/14 01/09/14 15/09/14 29/09/14 13/10/14 27/10/14 10/11/14 24/11/14 08/12/14 22/12/14 12/01/15 26/01/15 09/02/15 23/02/15 09/03/15 23/03/15 06/04/15 20/04/15 04/05/15 18/05/15 01/06/15 15/06/15 29/06/15 13/07/15 27/07/15 10/08/15 24/08/15 07/09/15 21/09/15 05/10/15 19/10/15 02/11/15 16/11/15 30/11/15 14/12/15 28/12/15 18/01/16 01/02/16 15/02/16 29/02/16 14/03/16 28/03/16 11/04/16 25/04/16 09/05/16 23/05/16 06/06/16 20/06/16 04/07/16 18/07/16 01/08/16 15/08/16 29/08/16 12/09/16 26/09/16 10/10/16 24/10/16 31/03/14 14/04/14 28/04/14 12/05/14 26/05/14 09/06/14 23/06/14 07/07/14 21/07/14 04/08/14 18/08/14 01/09/14 15/09/14 29/09/14 13/10/14 27/10/14 10/11/14 24/11/14 08/12/14 22/12/14 12/01/15 26/01/15 09/02/15 23/02/15 09/03/15 23/03/15 06/04/15 20/04/15 04/05/15 18/05/15 01/06/15 15/06/15 29/06/15 13/07/15 27/07/15 10/08/15 24/08/15 07/09/15 21/09/15 05/10/15 19/10/15 02/11/15 16/11/15 30/11/15 14/12/15 28/12/15 18/01/16 01/02/16 15/02/16 29/02/16 14/03/16 28/03/16 11/04/16 25/04/16 09/05/16 23/05/16 06/06/16 20/06/16 04/07/16 18/07/16 01/08/16 15/08/16 29/08/16 12/09/16 26/09/16 10/10/16 24/10/16 Number of Attendances Number of Admissions NUH & Circle Fast Track Trends Latest data 1,200 North & East Hospital Outpatient First Attendances 1-Apr-14 to 30-Oct North & East Daycase Admissions 1-Apr-2014 to 30-Oct , , / / / / / /17 Data Mean Value LCL LAL UAL UCL 4 per. Mov. Avg. (Data) Data Mean Value LCL LAL UAL UCL 4 per. Mov. Avg. (Data) 650 North & East A&E Attendances at NUH Major ED 1-Apr-2014 to 30-Oct Practice: (All) 310 North & East Emergency Admissions 1-Apr-2014 to 30-Oct / / / / / /17 Data Mean Value LCL LAL UAL UCL 4 per. Mov. Avg. (Data) Data Mean Value LCL LAL UAL UCL 4 per. Mov. Avg. (Data) 19

20 Financial Position against Commissioning Budget All Points of Delivery (PODs) Secondary Care SLAs, Continuing Care, Mental Health & Community Services April 2016 to August 2016 NHS North And East CCG April August 2016 Practice Name 2016/17 YTD Budget 2016/17 YTD Actual Spend 2016/17 YTD ( ) 2016/17 YTD (%) 1,067, , , % 3,654,416 3,632,080-22, % Om 672, ,265-2, % 4,170,624 4,219,422 48, % 1,323,388 1,355,520 32, % Torkard 5,315,973 5,452, , % 4,323,797 4,439, , % 2,084,507 2,143,687 59, % Lane 3,145,700 3,244,101 98, % 2,399,920 2,489,092 89, % 3,530,274 3,684, , % 4,544,845 4,769, , % 1,879,734 1,997, , % 4,523,967 4,812, , % 1,503,416 1,603,013 99, % 2,668,186 2,861, , % 1,251,016 1,352, , % 1,377,438 1,494, , % 2,564,145 2,795, , % 840, ,761 83,715 1% 1,731,295 1,971, , % North and East 54,572,445 56,843,582 2,271, % Main PODs BUDGET ACTUAL SPEND VARIANCE ( ) VARIANCE (%) A&E 1,583,477 1,793, , % Admitted Patients 22,685,484 22,939, , % Critical Care Bed Days 832, ,566 12, % Elective 8,201,579 8,093, , % Elective Excess Bed Days 66, ,979 49, % Inpatient Unbundled 426, ,192-70, % Non-Elective 11,638,296 11,888, , % Non-Elective Excess Bed Days 593, , , % GP Direct Access 858, ,771 36, % Other Activity 19,834,053 21,047,492 1,213, % Funded Nursing Care 585, , , % Continuing Health Care 5,667,100 6,372, , % Hearing Services Walk-ins 74,599 58,183-16, % Maternity Pathway 17,449 25,316 7, % Rehabilitation 303, , % Therapy Services 179, ,849 22, % Other Secondary Care 2,166,550 2,289, , % Local Tariff Activity 14,101 19,146 5, % Medical Appliances 343, ,058 7, % Outpatients 7,780,304 8,281, , % Outpatient First 1,990,020 2,160, , % Outpatient Follow Up 2,872,093 2,813,230-58, % Outpatient Procedures 2,652,484 2,933, , % Grand Total 54,572,445 56,843,582 2,271, % Grand total include sum of all PODs but list only shows the main PODs 20

21 Lane Om Financial Position for Main Spending Areas: A&E, Non Elective, Elective, Outpatients, Prescribing NNE CCG Practice Performance Against Budget ( ) - Only Main PODs: excludes CHC, Critical Care, Excess Bed Days and Other secondary Care Spend April August 2016 Torkard Underspend Overspend Lane NNE CCG Practice Performance Against Budget (%) - Only Main PODs: excludes CHC, Critical Care, Excess Bed Days and Other secondary Care Spend April August 2016 Torkard Om Underspend Overspend - 200, , , , ,000-10% -5% 0% 5% 10% 15% 21

22 Savings NiC / PU GP Prescribing Lane NNE CCG Practice Performance Against Budget (%) in Prescribing April August 2016 Om Torkard Underspend Overspend Sip Feeds: Net Ingredient Cost per Prescribing Unit Quarter /16 Quarter / ,000 10,000 8,000 6,000 4,000 2,000 0 OptimiseRX Actual Cost Savings in September % -10% 0% 10% 20% 30% 22